One of the most famous scenes in cinematic history is the heroin detox sequence in Trainspotting. Locked in his room to dry out, Renton, the film’s protagonist and heavy heroin user, is left to suffer an excruciating withdrawal process replete with cold sweats, overwhelming cravings, hallucinations, and, finally, screaming. The scene is abjectly horrifying and, for many, has come to serve as a cautionary tale about the disturbing consequences of addiction. For many users, fear of this kind of withdrawal keeps even those who recognize that they have a serious drug problem locked in a state of addiction as they seek to avoid the agony of withdrawal. For others, the absence of an overtly disturbing withdrawal experience keeps them from acknowledging their addiction altogether.

In reality, withdrawal encompasses a broad spectrum of observable and non-observable symptoms, and the experiences of those going through detox vary wildly. By understanding how drugs affect the brain, you can gain a greater insight into the withdrawal process, deconstruct the myths surrounding addiction, and realize the possibilities of healing.

The Impact of Drugs on Brain Activity

The brain is a remarkable and elegantly designed communication system comprised of 86 billion neurons that are in constant communication with each other through complex, interconnected networks. Within this system are over 50 different neurotransmitters that control our nervous systems, regulating everything from our moods to our sensory experiences to our sleep patterns.

Psychoactive drugs act directly on these neurotransmitters to induce altered states via artificial activation of the brain’s reward system. While different types of drugs affect the brain in different ways, all disrupt normal neural function by either putting our natural neurotransmitters—particularly serotonin and dopamine—into overdrive, or mimicking a particular transmitter. This mutated neurotransmitter activity is responsible for the feelings of euphoria, perceptual and sensory changes, and behavioral modifications that result from many types of drugs.

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The Neuro-Adaptation Process

For occasional users, drug-induced alteration of brain function is usually temporary. However, as Dr. Steven Batki, Medical Director and Chief Psychiatrist at Alta Mira Recovery Programs, says, “Repeated use of a drug changes the neurochemistry of a person’s brain.” Over time, the extraordinarily plastic nature of the brain allows drugs to create sustained modifications in neurotransmitter behavior. This process comes in two steps:

Tolerance: The brain adapts to the effects of a drug and requires higher amounts of the substance to induce the same effects. Tolerance may be built even by regular but casual users of certain substances; social drinkers, for example, typically have a higher tolerance to alcohol than people who only have a glass of champagne on New Year’s. The tolerance levels of heavy users, however, can be so high that they need dangerous amounts of a drug to produce the effects they desire and, in some cases, the drug stops working altogether.

Dependence: In response to the artificially induced neurotransmitter activation, the brain limits its natural production of neurotransmitters and, over time, comes to depend on a steady supply of the drug to maintain its fragile state of chemical equilibrium. When that supply is cut off, the brain finds itself with a shortage and goes into a state of withdrawal, creating a variety of physical symptoms. Some of these symptoms can easily be observed by others, while some are felt acutely by the user but are not readily observed.

Dependence can result from both legal and illegal substances, including medications taken as prescribed, and does not in itself imply addiction. What separates addiction from dependence is behavior and motivation. While dependent people can recognize the negative impact of their drug use and stop taking the drug, addicted people don’t.

Withdrawal Symptoms

Withdrawal from drug use can produce a host of observable and non-observable effects as the brain struggles to regain balance and resume normal neurotransmitter activity. The exact nature of each person’s symptoms depends on the type of drug they used, how much they used, and for how long they used. While some drugs are more likely to produce either observable or unobservable symptoms than others, many users experience a combination of both. Symptoms can range from mild discomfort and distress to life-threatening physical and psychological conditions.

Observable withdrawal symptoms can include:

Sweating

Muscle tension

Difficulty breathing

Tremors

Sleep problems

Nausea, vomiting, and diarrhea

Seizures

Heart failure

Non-observable withdrawal symptoms can include:

Anxiety and restlessness

Depression

Irritability

Concentration and memory problems

Social isolation

Changes in appetite

The Myth of Physical vs. Emotional Addiction

Addiction is recognized by major medical bodies as a chronic, relapsing brain disorder in which people continue to compulsively use despite negative consequences. One of the most pervasive and damaging myths about addiction is that a substance must produce observable withdrawal symptoms in order to be addictive. This misconception has led to the widespread belief that you cannot become addicted to certain types of drugs that are unlikely to lead to physical dependence, such as marijuanaand MDMA/Ecstasy. Not only is this inaccurate, it is also dangerous as it lulls users into a false sense of safety and may hinder the recognition of addiction and motivation to seek help. The truth is that non-observable withdrawal symptoms are just as real and potentially damaging as observable symptoms, and can in many cases cause more and longer-lasting distress than physical symptoms.

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Stages of Withdrawal

Acute Withdrawal: The acute stage of withdrawal happens during the initial detoxification phase and may last for days or weeks. This period is when observable symptoms are most likely to appear.

Post-Acute Withdrawal Syndrome: After acute withdrawal, post-acute withdrawal syndrome may set in. At this point, observable symptoms have largely ended and non-observable symptoms such as psychological and cognitive disturbances take center stage. The exact duration of post-acute withdrawal syndrome is largely dependent on the type and amount of drug used, but can last for up to two years in some cases.

While withdrawal may be long-lasting, it is important to remember that it is temporary. Whether symptoms disappear within days or endure for months, withdrawal does end, and the withdrawal process itself indicates that healing is happening.

Medical Supervision and Treatment of Withdrawal

Detoxing from certain types of drugs can be a physically and emotionally traumatic experience. In some cases, it can even be life-threatening, particularly if you are detoxing from benzodiazepines or alcohol. Medical supervision and treatment of withdrawal by physicians who specialize in addiction medicine can ensure that you stay safe and comfortable during the detoxification process. Medical monitoring may take place in either an inpatient or outpatient setting, and what is best for you depends on both the nature of your drug use and your personal preferences.

One of the benefits of medically supervised detox is access to a range of medications that can be used to alleviate both observable and non-observable symptoms, including anticonvulsants, antipsychotics, pain relievers, beta blockers, and benzodiazepines. You may also receive additional support through individual psychotherapy and therapy groups to help you cope with emotional distress. By working with experienced and compassionate professionals who are trained to guide you through the withdrawal process, you can be sure that you receive the care you need to have a healthy and positive detox experience as you begin your journey of recovery.

Towards Hope and Healing

The extraordinary ability of our brains to adapt to drug use may seem frightening, but the same plasticity that drives drug-induced neural changes can also be harnessed for healing. Ultimately, the withdrawal process is a signal that your brain is rebuilding and creating the chemical balance needed to achieve lasting recovery and freedom from drugs.

For a more in-depth look at how drugs and withdrawal affect the brain, we invite you to explore the infographic below and encourage you to share it with others.

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